Organization · Type 2 NPI

Mark D Thebaut DDS PC

Pediatric Dentistry · Lilburn, GA

NPI number 1447377130 Active

Practice location

609 Beaver Ruin Rd NW, Suite A
Lilburn, GA 30047-3401

Call (770) 925-3301 Map

Fax (770) 709-0001

Specialties and licenses

TaxonomyCodeLicense
Pediatric Dentistry Primary 1223P0221X9113 (GA)

Pediatric Dentistry: An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

5 other providers at this address

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About NPI 1447377130

Mark D Thebaut DDS PC's National Provider Identifier is 1447377130, issued on Mar 26, 2007. The primary taxonomy on file is Pediatric Dentistry (1223P0221X), and the practice location is in Lilburn, GA. The record was last updated on Jun 18, 2008.